1. Secondary Glaucoma Dated : 05-05-2017
- Prof Sanjeev Kumar Mittal

2. Definition
Types
Causes
Treatment

3. Secondary Glaucoma
Conditions with raised intraocular pressure due to pre existing ocular causes.
May manifest as-
Secondary open angle Glaucoma
Secondary angle closure Glaucoma
Mixed pattern

4. 1] lens induced glaucoma/Phakogenic
Phacomorphic glaucoma
Phacolytic glaucoma
Phacoanaphylactic glaucoma
Glaucoma associated with dislocated lens
[phakotopic]
v. Glaucoma capsulare/ Pseudoexfoliation syndrome

6. Inflammatory glaucoma
Intra ocular inflammation (inflammatory glaucoma): ▪ Associated with uveitis
Inflammatory glaucoma
1] Iridocyclitis (both in acute phase & chronic phases)
2] Glaucomato-cyclitic crisis /Hypertensive uveitis (Posner and Schlossmann’s syndrome)
3] Following perforated corneal ulcer
4] As a complication of Keratitis & scleritis

7. 3] Steroid-induced glaucoma
Iatrogenic cause
It is associated with topical, periocular, systemic or intraocular steroid therapy.
IOP rise after steroid therapy occurs more often with topical administration than with systemic administration.
Periocular injection of a long action steroid is the most dangerous route.
Intravitreal steroid use (Triamcinolone injection to treat intraocular neovascular or inflammatory disease) can also cause a rise in IOP.

8. vi. The response of IOP to steroids is genetically determined
vii. Rise in IOP occurs 6 weeks to 2 months
viii. Response varies in people
ix. Reversible
X . But we need to treat till it comes down

9. Pathogenesis:
deposition of mucopolysaccharides in trabecular meshwork
Reduced endothelial phagocytic activity
Inhibit synthesis of prostaglandins E and F which otherwise increase aqueous out flow.

10. Treatment:
Stop steroid
Treat with Drug for POAG
Surgery if medical treatment is unable to prevent damage to optic nerve

11. 4] Pigmentary Glaucoma Young myopic males
Deposition of iris pigments in trabecular meshwork damage
Krukenberg’s spindle (over corneal endothelium)
Gonioscopy (Sampaolesi’s line)

13. Glaucoma associated with intra ocular tumours
Causes:
Episcleral venous hypertension
(obstruction beyond trabecular meshwork)
Obstruction of angle by seeding of tumour cells
Forward displacement of Lens-iris diaphragm
eg- Thyroid exophthalmos,
Carotico-cavernous fistula
Superior vena cava syndrome
metastatic carcinoma of orbit
Retinoblastoma
Iris melanoma

14. Post-traumatic Glaucoma
[A] Blunt injury
Rise in IOP is biphasic
- early which lasts for few hours
- After few months/years (angle recession)
Gonioscopy is confimatory diagnosis- deeper angle recess with widening of ciliary band
[B] Penetrating injury
[C] Chemical injury

17. Neovascular glaucoma may be associated with all of the following except:
Diabetes
Hypertension
Central retinal vein occlusion
d. Intraocular tumours

18. Treatment of malignant glaucoma includes all except:
Topical atropine
Topical pilocarpine
IV mannitol
Vitreous aspiration

19. Secondary glaucoma following corneal perforation is due to:
Central anterior synechiae formation
Peripheral anterior synechiae
Intraocular haemorrhage
d. Angle recession

20. Glaukomflecken is a feature of:
Acute narrow-angle glaucoma
Pseudoexfoliative glaucoma
Juvenile glaucoma
Phacolytic glaucoma

21. All of the following are true about pigmentary glaucoma except:
It occurs more often in young myopic men
Iris transillumination defects are noted
It is associated with Krukenberg’s spindle
The intensity of pigment deposit in the angle is related to iris colour

22. After blunt trauma to eye Raja develops circumcorneal congestion
After blunt trauma to eye Raja develops circumcorneal congestion. Now, which test should be done?
(a) Ultrasonography
(b) Perimetry
(c) Direct ophthalmoscopy
(d) intraocular pressure measurement.

23. Thank you
Photographs taken from Clinical ophthalmology by Kanski